Treatment of spinal cord compression with the use of dexamethasone
Clinical Name of the drug
Corticosteroid Dexamethasone,this drug is a steroid used to reduce the size of masses or tumors with in the body.
General procedure for treatment and administration of the drug
A patient is admitted, by an Oncologist generally, to the hospital. Once the patient has been admitted a course of Dexamethasone is begun. This course is generally administered intravenously (via IV drip) and is closely monitored by the attending physician. Dexamethasone is generally delivered at first in dosing between 4 and 100 mgs determined by the Doctor. There is some controversy about proper dosing; however the standard is between 4 and 100 mgs every 6 hours. Dexamethasone is administered to reduce swelling and compression from the mass or tumor present. In return for the reduction of swelling and compression there is a relief in pain as well. After the first dose of Dexamethasone many Doctors will administer other daily doses of 16 to 96 mgs divided throughout several days to insure optimal performance of the drug.
During use of the drug patients must be supervised closely to watch for side effects of the drug. These side effects include but are not limited to:
- Immunosuppression: The lack of immune system support causing the patient to become ill from outside sources. (Maryjo Osowski RN)
- Gastrointestinal Irritation: Inflammation or other irritations of the GI tract. (Maryjo Osowski RN)
- Fluid Retention: Swelling in the hands and/or feet indicating the patient is not releasing water as well as they should be. (Maryjo Osowski RN)
- Euphoria: Overwhelming feeling of happiness without provocation. (Maryjo Osowski RN)
- Depression: Overwhelming feeling of sadness of worthlessness without provocation. (Maryjo Osowski RN)
- Hyperglycemia: A sudden and extraordinarily high spike in the natural blood glucose levels of the patient. (Maryjo Osowski RN)
With the last side effect of the list there is specific care needing to be taken with patients who are diabetic and receiving Dexamethasone treatment. These patients may need to have alterations in their diet and/or insulin while participating in treatment.
After treatment is completed
When treatment is complete and the mass or tumor has been decreased to the desired size patients as weaned from Dexamethasone as with any other steroid medication. This weaning happens at a rate of a 1/3 decrease in normal does every three to four day until the patient is completely weaned from the medication. During this time if the patient does not respond well to the weaning process Neurologic Deterioration can occur. In this instance a Doctor may find it necessary to administer a escalated trial dose of Dexamethasone to the patient and then begin the weaning process again with 1/3 the escalated dosing and working down to total elimination of Dexamethasone.
Maryjo Osowski RN, M. A. (n.d.). Spinal Cord Compression: An Obstructive Oncologic Emerngency. Retrieved from http://www.medscape.com/viewarticle/442735_6
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